Comparative analysis of standarts in the field of project management

Успешное функционирование проектно-ориентированных компаний предполагает необходимость использования международных и национальных стандартов с целью разработки методологии управления проектамиSuccessful functioning of the project-oriented companies requires the use of the international standards in order to develop a methodology for project managemen

Comparative analysis of standarts in the field of project management

Успешное функционирование проектно-ориентированных компаний предполагает необходимость использования международных и национальных стандартов с целью разработки методологии управления проектамиSuccessful functioning of the project-oriented companies requires the use of the international standards in order to develop a methodology for project managemen

Ультразвуковая оценка маневра рекрутирования альвеол у пациентов с тяжелой пневмонией

BACKGROUND. Ultrasound study significantly expanded the possibilities of bedside diagnosis in patients with respiratory failure. Using ultrasound, it is possible to determine the volume of lung damage in the form of collapsed alveoli and infiltration areas with preserved airness of the lung tissue. AIM OF STuDY To study the possibility of assessing the recruitment maneuver of the alveoli based on changes in the ultrasound signs of lung tissue damage.MATERIAL AND METHODS. A prospective study was performed in the Clinic of Anesthesiology and Resuscitation of S.M. Kirov Military Medical Academy. The study included 36 patients who were treated in the period from 2010 to 2017 with a duration of respiratory support of at least 48 hours and oxygenation index less than 300 mmHg. For 36 patients, 48 alveoli recruitment maneuvers were performed according to a step-by-step method under the control of dynamic compliance and average tidal volume. Ultrasound determined the type and extent of destruction of lung tissue by signs of infiltration and consolidation.RESULTS. In the studied patients, after carrying out a maneuver of recruitment of the alveoli, arterial blood oxygenation indices increased statistically significantly, PaCO2 level decreased, pulmonary tissue compliance improved, respiratory volume grew. All this confirmed the mobilization of the alveoli and improved lung ventilation. Ultrasonographic evaluation of lung tissue showed a significant decrease in the severity of the ultrasound sign of infiltration after recruitment maneuver from 46.5 (38; 57.5) to 37.5 (30.5; 49.5). However, recruitment had practically no effect on the volume of the consolidated area of lung tissue: the general consolidation index before (4 (3; 5)) and after (4 (3; 5)) the maneuver had no statistically significant differences.CONCLUSIONS. The pneumonia-affected consolidated lung tissue has a low recruitment potential and the volume of consolidation does not change with the growth of PEEP. After the recruitment maneuver, the number of B-lines decreases, indicating a decrease in infiltration and an increase in lung airness.Authors declare lack of the conflicts of interests.АКТУАЛЬНОСТЬ. Ультразвуковое исследование существенно расширило возможности прикроватной диагностики у пациентов с дыхательной недостаточностью. С помощью ультразвука имеется возможность определения объема поражения легких в виде коллабированных альвеол и зон инфильтрации с сохранением воздушности легочной ткани.ЦЕЛЬ ИССЛЕДОВАНИЯ. Изучить возможность оценки маневра рекрутирования альвеол на основании изменения ультразвуковых признаков поражения легочной ткани.МАТЕРИАЛ И МЕТОДЫ. Проспективное исследование выполнено в клинике анестезиологии и реаниматологии Военномедицинской академии им. С.М. Кирова. В исследование были включены 36 пациентов, которые находились на лечении в период с 2010 по 2017 г. с длительностью аппаратной респираторной поддержки не менее 48 часов; индексом оксигенации менее 300 мм рт.ст. Тридцати шести пациентам было выполнено 48 маневров рекрутирования альвеол по пошаговой методике под контролем динамической податливости и среднего значения дыхательного объема. При ультразвуковом сканировании определяли характер и объем поражения легочной ткани по признакам инфильтрации и консолидации.РЕЗУЛЬТАТЫ. У обследуемых пациентов после проведения маневра рекрутирования альвеол статистически значимо выросли показатели оксигенации артериальной крови, индекс оксигенации, снизился уровень PaСO2 , улучшилась податливость легочной ткани, увеличился дыхательный объем. Все это свидетельствовало о мобилизации альвеол и улучшении вентиляции легких. Сонографическая оценка легочной ткани показала существенное уменьшение выраженности ультразвукового признака инфильтрации после проведения маневра рекрутирования с 46,5 (38; 57,5) до 37,5 (30,5; 49,5). Однако рекрутирование практически не оказало влияния на объем консолидированной зоны легочной ткани: общий индекс консолидации до (4 (3; 5)) и после (4 (3; 5)) маневра не имел статистически достоверных различий.ВЫВОДЫ. 1) Пораженная пневмонией консолидированная легочная ткань имеет низкий рекрутабельный потенциал и при увеличении положительного давления в конце выдоха объем консолидации не меняется. 2) После маневра рекрутирования уменьшается количество В-линий, свидетельствующих о снижении инфильтрации и увеличении воздушности легких.Авторы заявляют об отсутствии конфликта интересов

МЕТОДИЧЕСКИЕ ПОДХОДЫ К АНАЛИЗУ ФИНАНСОВОЙ ДЕЯТЕЛЬНОСТИ ПРЕДПРИЯТИЯ ЭЛЕКТРОЭНЕРГЕТИКИ: РЫНОЧНЫЙ АСПЕКТ

This paper examines the current methodological approa-ches to the analysis of financial activity of electric power. Technical and economic indices of the enterprise energy are the parameters to identify the relationship between production and technological parameters on the one hand and economic performance on the other. Modern trends in the economic development of industrial enterprises actualized need to study the technical and economic indicators utilities through the prism of the main electricity consumers – owners. The paper presents the formalized methods of calculation of technical and economic parameters controlling the activities of energy companies.В статье рассматриваются современные методические подходы к анализу финансовой деятельности предприятия электроэнергетики. Технико-экономические показатели деятельности предприятия энергетики являются параметрами, выявляющими взаимосвязи между производственно-технологическими показателями с одной стороны и экономическими показателями с другой. Современные тенденции экономического развития промышленных предприятий актуализировали необходимость изучения технико-экономических показателей энергопредприятия через призму основных потребителей электроэнергии – собственников. В работе представлены формализуемые методы расчета технико-экономических параметров контроллинговой деятельности предприятий энергетики

Ultrasonography in the Assessment of Lung Recruitment in Patients with Severe Pneumonia

BACKGROUND. Ultrasound study significantly expanded the possibilities of bedside diagnosis in patients with respiratory failure. Using ultrasound, it is possible to determine the volume of lung damage in the form of collapsed alveoli and infiltration areas with preserved airness of the lung tissue. AIM OF STuDY To study the possibility of assessing the recruitment maneuver of the alveoli based on changes in the ultrasound signs of lung tissue damage.MATERIAL AND METHODS. A prospective study was performed in the Clinic of Anesthesiology and Resuscitation of S.M. Kirov Military Medical Academy. The study included 36 patients who were treated in the period from 2010 to 2017 with a duration of respiratory support of at least 48 hours and oxygenation index less than 300 mmHg. For 36 patients, 48 alveoli recruitment maneuvers were performed according to a step-by-step method under the control of dynamic compliance and average tidal volume. Ultrasound determined the type and extent of destruction of lung tissue by signs of infiltration and consolidation.RESULTS. In the studied patients, after carrying out a maneuver of recruitment of the alveoli, arterial blood oxygenation indices increased statistically significantly, PaCO2 level decreased, pulmonary tissue compliance improved, respiratory volume grew. All this confirmed the mobilization of the alveoli and improved lung ventilation. Ultrasonographic evaluation of lung tissue showed a significant decrease in the severity of the ultrasound sign of infiltration after recruitment maneuver from 46.5 (38; 57.5) to 37.5 (30.5; 49.5). However, recruitment had practically no effect on the volume of the consolidated area of lung tissue: the general consolidation index before (4 (3; 5)) and after (4 (3; 5)) the maneuver had no statistically significant differences.CONCLUSIONS. The pneumonia-affected consolidated lung tissue has a low recruitment potential and the volume of consolidation does not change with the growth of PEEP. After the recruitment maneuver, the number of B-lines decreases, indicating a decrease in infiltration and an increase in lung airness.Authors declare lack of the conflicts of interests

RUSSIAN EXPERIENCE WITH USING MONOCLONAL ANTIBODIES TO B-LYMPHOCYTES (RITUXIMAB) IN SYSTEMIC VASCULITIDES ASSOCIATED WITH NEUTROPHIL CYTOPLASMIC ANTIBODIES (PRELIMINARY RESULTS OF THE RUSSIAN REGISTER NORMA)

In 2013, Russia registered officially the indications for the use of monoclonal antibodies to B-lymphocytes (rituximab, RTM) in systemic vasculitides associated with antineutrophil cytoplasmic antibodies (ANCA-SV). This communication presents the preliminary results of the Russian register of the RTM application in autoimmune diseases (NORMA) that has included 50 patients with ANCA-SV treated in 14 cities of the Russian Federation. Twenty-five of 50 (50%) patients received repeated courses of RTM. RTM has demonstrated a high efficacy and a good profile of treatment safety in patients with ANCA-SV in real-life national clinical practice. Among 25 patients who had been followed up for over 12 months, the remission was achieved in 92% of cases, a decrease in the ANCA-SV activity was observed in 8%. The efficacy of RTM increased when performing repeated courses, while it has been noted that the positive results can be obtained by prescribing a repeated course of RTM at a reduced dose (500–1000 mg). Prescription of the repeated courses was primarily required in patients with granulomatosis and polyangiitis affecting the lungs. Care should be taken when combining RTM treatment with cytostatics (primarily with cyclophosphamide) because of the risk of secondary immunodeficiency and infectious adverse events (AE), which have been the most frequent serious AE (12%) in patients with ANCA-SV